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This was the standard conservative argument for a long time: HSAs and non-comprehensive insurance. It’s just what conservatives have been saying for the last 60

by xnyan 7y ago

This was the standard conservative argument for a long time: HSAs and non-comprehensive insurance. It’s just what conservatives have been saying for the last 60 years (only give benefits that have meaning to those who already have money), and not even they are trying that tactic anymore. I would be interested if any country has a system that reflects the ideas outlined by the writer, and if so what the results were. All the successful healthcare systems I am aware of our nationalize either at the hospital level, administration and financial level or some combination of the both.

WalterBright 7y ago
> if any country has a system that reflects the ideas outlined by the writer The article points out that Lasik eye surgery is not covered by government programs or private insurance, and the price of it has declined dramatically over the years while the quality of it has improved.
- danans 7y ago
  Lasik is 100% elective, and nobody needs it done immediately to save their lives or relieve their suffering. It's a cosmetic procedure - like liposuction - one that you can shop around for until you find the right provider. You can't compare it to the type of non-elective or emergency procedures performed in other areas of health care, or treatments for severe chronic conditions. You can't even compare it to routine doctors' visits which are often put off by uninsured people due to the costs, allowing minor conditions to develop into more severe (expensive) ones.
  - WalterBright 7y ago
    I've been to the doctor many times in my life, and absolutely none of them were critical in any way. This is what the vast bulk of medical care is. They absolutely can be shopped around for best price and service. Consider also that nearly all medical conditions have a variety of treatment options available, varying in effectiveness, time, pain, risk, and cost. For example, I recently had a tooth problem where the dentist laid out quite a range of options, all varying wildly in terms of efficacy, pain, time in the dental chair, risk, and yes, cost. It also had a year or so before it would become an emergency situation. No, I don't have dental insurance. This is what a more of a free market approach would look like. I've also had success negotiating the fees doctors charge for office visits, it's as simple as asking in advance what it will cost, and then just asking for a discount. That's all I do, and I often get a third off just for asking. You bet you can negotiate. Doctors are not offended by this. The ones with their own practice are businessmen. If you don't ask/negotiate you get the sucker price, just as if you went to a car dealer and failed to ask the price and negotiate. What you cannot negotiate with is Obamacare. I am forced by law to get health insurance at the price set by the state insurance commissioner.
    - danans 7y ago
      > I've been to the doctor many times in my life, and absolutely none of them were critical in any way. Consider yourself lucky, you are an n of 1. > This is what the vast bulk of medical care is. They absolutely can be shopped around for best price and service. And it will have a little effect on the overall cost of medical care in this country. 5% of patients with extreme conditions account for 50% of healthcare spending. https://www.newyorker.com/magazine/2011/01/24/the-hot-spotters https://www.newyorker.com/magazine/2011/01/24/the-hot-spotte... > This is what a more of a free market approach would look like. How would it look when you have a repeated anaphylactic reaction to an unknown allergen that puts you repeatedly in emergency care? When you discover you have stage three cancer at age 50 and will die very soon unless you immediately start chemo? When you are 34 and discover you have a degenerative condition in your hip which requires a hip reconstruction that only two surgeons in your metro area can perform, or leave you handicapped? All of those have happened to people I know. Not sure how the free market would have helped in those situations. Insurance helped to varying degrees, but there were significant bills and co-pays.
      - WalterBright 7y ago
        Hospitals and clinics are full of patients who did not arrive by ambulance. All you need to do is look at the packed parking lot. Have you ever tried the magic words when you make an appointment: 1. how much will this cost? 2. that sounds high - can you discount it? Don't say that's impossible until you try it a few times. I do, and it usually results in an immediate discount of 10-30%, with the condition that I pay in advance. It's the same when I take my car in for service, book hotel rooms, or even when buying furniture. I have a friend who regularly needs surgery for kidney stones. He calls hospitals one by one, utters the magic words, gets discounts, then picks a hospital. Sometimes, he gets the sucker bill anyway, then reminds them that they'd agreed to the lower price. Don't knock it till ya try it.
refurb 7y ago
That approach is pretty much what Singapore system looks like. The gov't intentionally didn't reimburse 100% of healthcare costs, they want patients to have some skin in the game to control utilization. Of course it has it's own issues, but the Singapore system works pretty well. If you're destitute, there is a government plan that provides healthcare. For everyone else, it's a forced savings plan that everyone has to contribute to. You can then make a choice as a consumer to either take the basic insurance (80% of costs covered for a basic ward where you have 6 patients to a room) or get your own private room that the gov't covers 50% of and you're responsible for the rest (typically though insurance).
- danans 7y ago
  > If you're destitute, there is a government plan that provides healthcare. For everyone else, it's a forced savings plan that everyone has to contribute to. So either totally government provided for the destitute, and a "forced savings plan" for most people, which is basically a tax/mandate. > You can then make a choice as a consumer to either take the basic insurance > or get your own private room that the gov't covers 50% of and you're responsible for the rest So the Singapore government is involved in subsidizing nearly all insurance choices all the way up to the high end, presumably funded by taxes. They also heavily regulate healthcare costs to keep them low instead of leaving it to the "free" market. Sure doesn't sound like what proposals like voluntary HSAs and their ilk propose in the US. The proponents of those stridently oppose any government regulation of healthcare costs or measures to ensure universal coverage. Instead, in the US, we consumers have plenty of skin in and the game, huge uncertainty and disproprortionate leverage put in the hands of our employers and health insurance companies, lack of universal coverage, and worse average outcomes.
  - refurb 7y ago
    I was speaking more to the cost-sharing aspect, which is a big distinction among different systems. In Canada, you pay $0 at the point of care, while other systems (Singapore) require consumers to have skin in the game. Agree that implementing cost sharing without transparency into pricing is a bad approach.

by xnyan 7y ago

WalterBright 7y ago

> if any country has a system that reflects the ideas outlined by the writer The article points out that Lasik eye surgery is not covered by government programs or private insurance, and the price of it has declined dramatically over the years while the quality of it has improved.

danans 7y ago
Lasik is 100% elective, and nobody needs it done immediately to save their lives or relieve their suffering. It's a cosmetic procedure - like liposuction - one that you can shop around for until you find the right provider. You can't compare it to the type of non-elective or emergency procedures performed in other areas of health care, or treatments for severe chronic conditions. You can't even compare it to routine doctors' visits which are often put off by uninsured people due to the costs, allowing minor conditions to develop into more severe (expensive) ones.
- WalterBright 7y ago
  I've been to the doctor many times in my life, and absolutely none of them were critical in any way. This is what the vast bulk of medical care is. They absolutely can be shopped around for best price and service. Consider also that nearly all medical conditions have a variety of treatment options available, varying in effectiveness, time, pain, risk, and cost. For example, I recently had a tooth problem where the dentist laid out quite a range of options, all varying wildly in terms of efficacy, pain, time in the dental chair, risk, and yes, cost. It also had a year or so before it would become an emergency situation. No, I don't have dental insurance. This is what a more of a free market approach would look like. I've also had success negotiating the fees doctors charge for office visits, it's as simple as asking in advance what it will cost, and then just asking for a discount. That's all I do, and I often get a third off just for asking. You bet you can negotiate. Doctors are not offended by this. The ones with their own practice are businessmen. If you don't ask/negotiate you get the sucker price, just as if you went to a car dealer and failed to ask the price and negotiate. What you cannot negotiate with is Obamacare. I am forced by law to get health insurance at the price set by the state insurance commissioner.
  - danans 7y ago
    > I've been to the doctor many times in my life, and absolutely none of them were critical in any way. Consider yourself lucky, you are an n of 1. > This is what the vast bulk of medical care is. They absolutely can be shopped around for best price and service. And it will have a little effect on the overall cost of medical care in this country. 5% of patients with extreme conditions account for 50% of healthcare spending. https://www.newyorker.com/magazine/2011/01/24/the-hot-spotters https://www.newyorker.com/magazine/2011/01/24/the-hot-spotte... > This is what a more of a free market approach would look like. How would it look when you have a repeated anaphylactic reaction to an unknown allergen that puts you repeatedly in emergency care? When you discover you have stage three cancer at age 50 and will die very soon unless you immediately start chemo? When you are 34 and discover you have a degenerative condition in your hip which requires a hip reconstruction that only two surgeons in your metro area can perform, or leave you handicapped? All of those have happened to people I know. Not sure how the free market would have helped in those situations. Insurance helped to varying degrees, but there were significant bills and co-pays.
    - WalterBright 7y ago
      Hospitals and clinics are full of patients who did not arrive by ambulance. All you need to do is look at the packed parking lot. Have you ever tried the magic words when you make an appointment: 1. how much will this cost? 2. that sounds high - can you discount it? Don't say that's impossible until you try it a few times. I do, and it usually results in an immediate discount of 10-30%, with the condition that I pay in advance. It's the same when I take my car in for service, book hotel rooms, or even when buying furniture. I have a friend who regularly needs surgery for kidney stones. He calls hospitals one by one, utters the magic words, gets discounts, then picks a hospital. Sometimes, he gets the sucker bill anyway, then reminds them that they'd agreed to the lower price. Don't knock it till ya try it.

refurb 7y ago

That approach is pretty much what Singapore system looks like. The gov't intentionally didn't reimburse 100% of healthcare costs, they want patients to have some skin in the game to control utilization. Of course it has it's own issues, but the Singapore system works pretty well. If you're destitute, there is a government plan that provides healthcare. For everyone else, it's a forced savings plan that everyone has to contribute to. You can then make a choice as a consumer to either take the basic insurance (80% of costs covered for a basic ward where you have 6 patients to a room) or get your own private room that the gov't covers 50% of and you're responsible for the rest (typically though insurance).

danans 7y ago
> If you're destitute, there is a government plan that provides healthcare. For everyone else, it's a forced savings plan that everyone has to contribute to. So either totally government provided for the destitute, and a "forced savings plan" for most people, which is basically a tax/mandate. > You can then make a choice as a consumer to either take the basic insurance > or get your own private room that the gov't covers 50% of and you're responsible for the rest So the Singapore government is involved in subsidizing nearly all insurance choices all the way up to the high end, presumably funded by taxes. They also heavily regulate healthcare costs to keep them low instead of leaving it to the "free" market. Sure doesn't sound like what proposals like voluntary HSAs and their ilk propose in the US. The proponents of those stridently oppose any government regulation of healthcare costs or measures to ensure universal coverage. Instead, in the US, we consumers have plenty of skin in and the game, huge uncertainty and disproprortionate leverage put in the hands of our employers and health insurance companies, lack of universal coverage, and worse average outcomes.
- refurb 7y ago
  I was speaking more to the cost-sharing aspect, which is a big distinction among different systems. In Canada, you pay $0 at the point of care, while other systems (Singapore) require consumers to have skin in the game. Agree that implementing cost sharing without transparency into pricing is a bad approach.